Thrombin activation of endometrial endothelial cells: A possible role in intrauterine growth restriction

Graciela Krikun; Se-Te Joseph Huang; Frederick Schatz; Carolyn Salafia; Carlos Stocco; Charles J Lockwood

doi:10.1160/TH06-07-0387

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2007; 97(02): 245-253
DOI: 10.1160/TH06-07-0387

Endothelium and Vascular Development

Schattauer GmbH

Thrombin activation of endometrial endothelial cells: A possible role in intrauterine growth restriction

Authors

Graciela Krikun

¹The Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut, USA;
Se-Te Joseph Huang

¹The Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut, USA;
Frederick Schatz

¹The Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut, USA;
Carolyn Salafia

²The Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
Carlos Stocco

¹The Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut, USA;
Charles J Lockwood

¹The Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut, USA;

Abstract

Summary

Preeclampsia (PE), intrauterine growth restriction (IUGR) and abruption with or without fetal loss are associated with reduced uteroplacental blood flow, decidual vasculopathy, endothelial cell dysfunction, thrombosis, inflammation and hemorrhage. Our hypothesis is that reduced uteroplacental blood flow causes focal decidual hypoxia that generates vascular endothelial growth factor (VEGF). The latter acts directly on decidual endothelial cells to induce aberrant expression of tissue factor (TF), the primary initiator of coagulation. This in turn generates thrombin that induces: i) further TF expression; and ii) inflammatory cytokines. BothVEGF and TF induce aberrant angiogenesis-vessel maintenance reflected by endothelial cell fenestrations and induction of a prothrombotic surface causing both the decidual hemorrhage (i.e.abruption) and thrombosis (i.e.uteroplacental vascular insuf- ficiency) observed in these adverse pregnancy outcomes. This novel hypothesis is supported by our finding of TF expression in decidual endothelium of pregnancies complicated by IUGR and/ or fetal loss. Moreover, treatment of cultured endometrial endothelial cells with VEGF or thrombin induces TF protein and mRNA expression. Quantitative RT-PCR analysis indicates that thrombin enhances (>10-fold) the output of diverse inflammatory cytokines in these cultures. The greatest effect (>2-log) was seen on macrophage inflammatory protein 3 α (MIP3 α ). In vitro, thrombin results in endometrial endothelial cell aggregations and changes in the apoptotic pathway. Thus, we postulate that reductions in uteroplacental flow initiate a cascade of molecular effects leading to hypoxia, thrombosis, inflammation, and endothelial cell dysfunction resulting in untoward pregnancy outcomes.

Keywords

Angiogenesis and inhibitors - pregnancy - inflammation - haemostasis - cytokines

Full Text

References

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